Abstract

BackgroundTo determine the antibacterial effect of photodynamic Therapy on Enterococcus faecalis (E. faecalis) biofilms in experimentally infected human root canals in primary infections and endodontic retreatments.MethodsOne hundred and sixty single-rooted extracted teeth with one root canal were prepared using ProTaper instruments. Seventy specimens were left without root canal filling and autoclaved. The root canals of another 70 specimens were filled with Thermafil and AH Plus and the root canal fillings were removed after 24 hours using ProTaper D files and plasma sterilized. The specimens were infected with a clinical isolate of E. faecalis for 72 hours. Samples were taken using sterile paper points to determine the presence of E. faecalis in the root canals. The specimens were randomly divided into groups according to their treatment with 20 teeth each and a control. In the PDT group the teeth were treated using PDT, consisting of the photosensitizer toluidine blue and the PDT light source at 635 nm. In the NaOCl (sodium hypochlorite) group the root canals were rinsed with 10 mL of 3% NaOCl. In the NaOCl-PDT group the root canals were rinsed with 10 mL of 3% of sodium hypochlorite and then treated with PDT. Samples were taken after treatments using sterile paper points. Additionally, remaining root canal filling material was recovered from the root canal walls. Survival fractions of the samples were calculated by counting colony-forming units. A one-way analysis of variance (ANOVA) was applied to the data to assess the effect of different treatment techniques.ResultsAntimicrobial treatment of root canals caused a significant reduction of bacterial load in all groups. NaOCl irrigation eliminated E. faecalis most effectively. PDT alone was less effective compared to NaOCl irrigation and the combination of NaOCl irrigation and PDT. CFU levels recovered from the filling material after NaOCl irrigation of the root canals were 10fold higher compared to PDT and the combination of NaOCl irrigation and PDT.ConclusionsPhotodynamic therapy killed E. faecalis in experimental primary endodontic infections and retreated human root canals. PDT is an effective supplement in root canal disinfection, especially in endodontic retreatments.

Highlights

  • To determine the antibacterial effect of photodynamic Therapy on Enterococcus faecalis (E. faecalis) biofilms in experimentally infected human root canals in primary infections and endodontic retreatments

  • Previous studies have shown that root canal filling material cannot be removed completely leaving gutta-percha and/or sealer on the root canal wall making disinfection of the root canal system more difficult compared to primary root canal treatments [9,10,11]

  • They found that Photodynamic therapy (PDT) as an adjuvant to conventional endodontic treatment leads to a significant further reduction of bacterial load after irrigation using sodium hypochlorite, hydrogen peroxide and EDTA and is effective against multi-drug resistant bacteria

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Summary

Introduction

To determine the antibacterial effect of photodynamic Therapy on Enterococcus faecalis (E. faecalis) biofilms in experimentally infected human root canals in primary infections and endodontic retreatments. Post-treatment disease associated with poor endodontic treatment may be caused as a result of not using rubber dam, poor access resulting in missed untreated root canals, inadequate instrumentation, inadequate disinfection, inadequate root canal filling or iatrogenic errors, e.g. fractured instrument, perforation, ledge [8]. Root canal retreatment is considered more difficult compared to primary root canal treatment as there are usually intracanal obstacles to overcome, e.g. gutta-percha removal, intracanal materials such as silver points, posts or fractured instruments, correcting iatrogenic errors such as ledges or perforations [8]. After removal of root canal filling and other intracanal obstacles residual bacterial contamination has to be reduced to a minimum for successful endodontic treatment [12]. Chlorhexidine and iodine compounds have been advocated as additional irrigants for root canal (re)treatment [14]

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